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General NPI Number Information
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NPI Number | 1982856027
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Entity Type | Individual
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Provider Name | THERESA KATHERINE FARRELL DMD
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Gender | Female
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Dates
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Enumeration Date | 10/21/2008
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Last Update Date | 10/21/2008
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Provider Practice Location Address
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Address Line | 336 WESTWOOD AVE
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City | WESTWOOD
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State | NJ
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Zip | 07675-1717
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Country | US
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Telephone | 201-594-9991
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Fax | 201-594-9981
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Provider Business Mailing Address
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Address Line | 336 WESTWOOD AVE
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City | WESTWOOD
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State | NJ
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Zip | 07675-1717
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Country | US
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Telephone | 201-594-9991
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Fax | 201-594-9981
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 22DI01686100
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License Number State | NJ
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